Mental Health Counseling Practicum and Internship Manual

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Mental Health Counseling

Practicum and Internship Manual

Mental Health Counseling Program

Department of Counseling

Gallaudet University

800 Florida Ave., NE

Washington, DC 20002

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Table of Contents

Overview of the Manual 3

Introduction to the Department of Counseling 4 Introduction to the Mental Health Counseling Program 4

Core Program of Studies 5

Organization of Practicum and Internship 6

Student Professional Liability Coverage 7

Student Performance 7

Site Supervisor Guidelines 9

Student Trainee Guidelines 11

Faculty Supervisor Guidelines 13

Forms -

Practicum Approval Form 15

Practicum/Internship I, II, and III Information Form 16

Internship I Approval Form 17

Internship II Approval Form 18

Internship III Approval Form 19

Supervision Agreement and Trainee Goals 20

Counseling Session Process Notes 23

Group Session Process Notes 24

Practicum/Internship Time Log 25

Comprehensive Time Log 27

Observation Form 28

Trainee Evaluation Form - Practicum 29

Trainee Evaluation Form - Internship I 32

Trainee Evaluation Form - Internship II 35

Trainee Evaluation Form - Internship III 38

Evaluation of Site Supervisor 41

Evaluation of Faculty Supervisor 44

Appendices - Ethical Guidelines and Standards 46

ACA Code of Ethics 48

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Overview of the Manual

This manual is designed for both students and site supervisors. It includes necessary information for navigating the process of both being a Gallaudet University Department of Counseling trainee and being a supervisor. It also includes our professional counselor Code of Ethics.

Site supervisors will find basic information about the Department of Counseling and the Mental Health Counseling Program as well as specific supervisor roles and responsibilities. This manual is not designed to add to your responsibilities as a supervisor, but rather to take you easily through the process of supervising our students. Here you will find all forms that you will need for both recording training experiences and evaluating performance.

Students should read this manual carefully. Here you will find a comprehensive listing of roles and responsibilities of being a trainee. You will also find all forms needed for proceeding through the practicum and internship process,

documenting training experiences, and evaluating performance.

The supervisory experience may very likely be one of the most rewarding experiences of your life, both as a supervisee and a supervisor. The best supervisory relationships have been described by our students as being safe, honest, warm, creative, and genuine. Students appreciate supervisors who show a real interest, are generous with sharing counseling techniques and skills, give uninterrupted attention and time, pay attention to both verbal and non-verbal communication, and are respectful. Respect is a two way street and is a quality supervisors also wish from their supervisees, along with open and honest

communication, and a commitment to exploring both their own processes and those of their clients’. It is these qualities that good supervisor/supervisee relationships are built on.

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Introduction to the Department of Counseling

The Department of Counseling was established at Gallaudet University in 1971 and the first graduates received their degrees in 1974. Over the years there have been many changes, but the original premise of the department remains. We believe that all individuals who are deaf or hard of hearing have the right to equal opportunity and access to counseling provided by counselors who are highly qualified and competent. We are committed to both finding individuals who wish to do this work, and to training them in the knowledge, skills, and dispositions counselors need.

The Department currently has three programs: Mental Health Counseling Program, School Counseling Program, and the School Counseling Program - Summers Only Option. We are accredited by the Council on Accreditation of Counselor Education Programs (CACREP). Our students are eligible to apply for National Certified Counselor (NCC) credentials prior to graduation. The School Counseling Programs are also accredited by the National Council on

Accreditation of Teacher Education Programs (NCATE) and by the District of Columbia.

For information, please contact Dr. Roger Beach, Department Chair at (202) 651-5515 or roger.beach@gallaudet.edu.

Introduction to the Mental Health Counseling Program The Mental Health Counseling Program was initiated in 1986, because of a national need to provide appropriate counseling and mental health services to deaf and hard-of-hearing adults, children, and adolescents in mental health centers, psychiatric hospitals, community programs, addiction programs, and psychosocial rehabilitation programs. We are the only graduate training program in the world that specializes in preparing mental health counselors to do clinical or community work with deaf and hard-of-hearing people. Our focus is threefold – training in mental health counseling, knowledge and understanding of deaf and hard-of-hearing people, and fluency in American Sign Language. The program has increasingly infused multiculturalism throughout its curricula. Field work, which is required over 4 semesters, is seen as a major emphasis of the professional training program. The core curriculum for the Mental Health Counseling Program is on the next page.

For information, please contact Dr. Jeffrey Lewis, Program Director at (202) 651-5515 or jeffrey.lewis@gallaudet.edu. Other dedicated program faculty are Linda Lytle, Ph.D. (linda.lytle@gallaudet.edu) and Kendra Smith, Ph.D.

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CORE PROGRAM OF STUDIES

MENTAL HEALTH COUNSELING (RECOMMENDED SEQUENCE) First Semester

EDF 730 Social and Multicultural Counseling 3 COU 710 Orientation to the Profession of Mental

Health Counseling 3

COU 717 Childhood Development, Disorders and Disabilities 3

COU 721 Foundation in Helping Skills I 3

COU 732 Theories and Approaches in Counseling and

Psychotherapy 3

COU 795 Simulated Society 1

--- 16 Second Semester

COU 709 Psychological Aspects of Deafness 3

COU 714 Adult Psychopathology 3

COU 716 Psychopharmacology for Counselors 1 COU 740 Practicum in Counseling 4 COU 748 Principles of Assessment in Counseling 3 COU 753 Group Psychotherapy 3 ---

17 Third Semester (Summer)

COU 728 The Cycle of Substance Abuse 3

COU 736 Organization and Administration of Human Services 3

COU 740 Internship I in Mental Health Counseling 2-4

--- 8-10 Fourth Semester

COU 715 Family Therapy 3

COU 734 Lifestyles & Career Development 3

COU 740 Internship II in Mental Health Counseling 4 EDF 720 Introduction to Research in Education and

Human Services 3

COU 768 Advanced Techniques and Skills in Psychotherapy 3

--- 16 Fifth Semester

COU 790 Internship III in Mental Health Counseling 12 TOTAL NUMBER OF CORE HOURS 69-71

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Organization of Practicum and Internship

Counseling trainees engage in 4 different levels of fieldwork experience in various settings, including mental health agencies, substance abuse treatment centers, university counseling centers, centers for abused women, and

psychiatric treatment facilities.

Students begin their fieldwork with a practicum during their second semester in the program. This practicum is helpful in assisting students in “putting on” the role of counselor, learning about the services offered, observing others, and

beginning to apply their emerging counseling skills. It is also an introduction to understanding agency work. This practicum is a total of 200 clock hours, and 40 - 80 direct client contact hours, two days a week, in a mental health setting with deaf and hard-of-hearing clients in the Washington, DC area. The Program Director assists students with the site selection and placement, pairing students with supervisors who typically have been working with our students for many years.

Internship I and Internship II typically take place in the summer and fall semesters of the student’s second year. The counselor trainee should now be comfortable in their new role and start to take on more responsibilities.

Internships I and II are two–day-a-week placements and most often continue in the same agency as the practicum. It is expected that students will obtain a minimum of 400 clock hours and a minimum of 80 client contact hours during Internship I and Internship II.

Internship III is the most advanced fieldwork experience and spans a full semester, full-time, 5 days/wk, at a placement typically outside of the Washington, DC area. Internship III is designed to allow students to gain

experience in nearly all aspects of the counselor role and they are seen as fully contributing members of the agency to which they are assigned. During this final internship, students should obtain 600 clock hours and 240 direct client contact hours. While faculty are available to assist with site placement, students are encouraged to carefully explore options and to seek agencies which allow them to gain experience that fits with their career interests and goals. In summary, it is expected that students will have a minimum of the following hours:

Practicum: 200 clock hours 40 client hours Internship I: 200 clock hours 40 client hours Internship II: 200 clock hours 40 client hours Internship III: 600 clock hours 240 client hours

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Student Professional Liability Coverage

Gallaudet University carries professional liability insurance for students in

training. Students are required to purchase additional student liability insurance through the American Counseling Association (ACA) or other insurance carriers. These student policies can be obtained at a very reasonable rate. It is

particularly important that you purchase an individual policy as you will often be completing training hours outside of the regular university semester dates.

Student Performance

It is understood that practicum and internship experiences are processes and that personal and professional growth is cumulative. Trainees are expected to be open to their own self-exploration, to be willing to examine their counseling interaction and skill development, and to be open to the process of supervision. Integration of theoretical knowledge and practical experience is expected. Nevertheless, sometimes trainees do not progress through training as expected and desired.

If student performance is of concern, site supervisors are expected to immediately share these concerns with both the student and the faculty

supervisor. Faculty supervisors can then be very helpful in assisting the training process by, for example, changing the nature of the supervision process or increasing the amount of supervision.

In addition there are occasions when ethical concerns are present. Effective performance of counseling duties, while adhering to professional ethics, is a part of the skill set trainees need to develop. Accordingly the Department sees it as part of their duty to assure that trainees have opportunities to openly discuss issues of ethical behavior and furthermore to ascertain that they have sufficient support to correct behavior which may be problematic. Any concern about ethical behavior, difficulty with boundaries, and/or moral decision making should be shared with the faculty supervisor immediately. The faculty supervisor and department faculty, in consultation with both student and site supervisor, will decide on action needed.

Remediation of professional performance deficiencies is a responsibility the Department takes seriously. Additional coursework, personal psychotherapy, or changes of placement sometimes make a big difference and the trainee is often able to continue training successfully. At other times, the faculty may determine that more serious action is needed and the Program Director may require a

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withdrawal of the trainee from their placement. In other circumstances, it is possible the student will be asked to withdraw from the Program. The intent is always foremost to protect client welfare.

Confidentiality and Ethics:

Supervision is a confidential process, similar to the therapy process. Personal and confidential information will likely be shared among trainees during group supervision and between trainee and site and faculty supervisors during

individual supervision. It is the supervisor’s and student’s responsibility to adhere to the ACA code of ethics with regard to confidentiality. Information expressed by others (e.g., supervisors or peers in group supervision) should not be shared outside of supervision. The supervisor/supervisee relationship has the same limits to confidentiality that exist in the therapy relationship and supervisors are obligated to break confidentiality to protect supervisees from harming themselves or others (e.g., clients).

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Practicum/Internship Site Supervisor Guidelines

The Gallaudet University Department of Counseling sees our Site Supervisors as vital components of our training program and as partners in the development of professional counselors working with deaf and hard-of-hearing individuals and their families. You, your skills, and your knowledge, are highly valued. We also recognize that you are taking on considerable professional responsibility in agreeing to supervise our students’ clinical work. To honor and assist in this important supervisory role, we offer this guideline.

As a Practicum/Internship Site Supervisor, I agree to:

1. Provide appropriate physical work space, private office space for client sessions, telephone/tty/videophone, internet hook-up, and supplies.

2. Provide orientation to the agency operating procedures, policies, goals, and employees. 3. Provide a full range of professional counselor experiences.

4. Allow trainee to review client files.

5. Identify an appropriately trained, licensed, and certified individual to provide supervision. This individual ideally has a Master’s or Doctoral degree in Counseling or related field and holds certification in their professional field. Supervisors should have a minimum of two years professional experience as a counselor and training in supervision.

6. Consistently provide a minimum of one hour a week one-on-one supervision and be available daily for consultation.

7. Involve trainee in clinical meetings, such as treatment team meetings, clinical staffings, and agency supervision meetings.

8. Provide certified ASL interpreters for deaf and hard-of-hearing trainees as needed for supervision, meetings, and training.

9. Allow trainee to take part in agency in-service and training opportunities.

10. Allow trainee both time and technology to meet with their faculty supervisor. For out of town internships, this means 1 hour weekly individual supervision by videophone/telephone and one and a half hours weekly group supervision using AIM chatroom, BlackBoard, telephone, or other synchronous method.

11. Communicate with Gallaudet University faculty promptly if there is any concern about student performance or ethics.

12. Observe trainee’s work with clients a minimum of twice a semester Observations may be through a one-way window, videotape, or live.

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13. Allow video or audio tapes of client sessions (with client permission) to be reviewed by the faculty supervisor if requested.

14. Provide formative evaluation of student performance as well as summative evaluation. 14. Complete the following forms in a timely manner:

Supervision Agreement and Trainee Goals Observation form

Trainee Evaluation Form - Mid-semester evaluation Trainee Evaluation Form - Final evaluation

Site Supervisor Signature ____________________________ Date____________________________________________

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Practicum/Internship Trainee Guidelines

As a counselor trainee from the Gallaudet University Department of Counseling you are entering a vital component of your training program. Practicum and internships are collaborative partnerships among your department and faculty, your agency and site supervisor, and yourself. As a trainee, you enter into a rich learning environment, and grow in ways that are truly remarkable. To honor and assist in this important trainee role, we offer this guideline.

As a Practicum/Internship Trainee, I agree to: 1. Obtain student professional liability insurance.

2. Maintain professional appearance, punctuality, and behavior.

3. Become aware of the agency operating procedures, policies, goals, and employees. 4. Participate in a full range of professional counselor experiences appropriate to my level of development.

5. Review my client files and keep entries up to date.

6. Participate in a minimum of one hour a week one-on-one supervision with your site supervisor. 7. Participate in clinical meetings, such as treatment team meetings, clinical staffings, and agency supervision meetings.

8. Participate in agency in-service and training opportunities.

9. Attend weekly supervisory meetings with my faculty supervisor. Weekly individual meetings of one hour each are required, as well as group meetings of one and a half hours each. For out-of-town internships, this means 1 hour weekly individual supervision by telephone or videophone and one and a half hours weekly group supervision using telephone, AIM chatrooms or

BlackBoard. I will talk with my site supervisor prior to beginning the internship to make sure this technology is available to me.

10. Communicate with Gallaudet University faculty promptly if there is any concern about performance or ethics.

11. Make arrangements for my site supervisor to observe my work with clients a minimum of twice a semester. This observation may be through a one-way window, videotape, or live (in-room). I will be sure to have obtained the appropriate signed informed consent releases. 12. Make video or audio tapes of client sessions (with client permission) to be reviewed by the faculty supervisor if requested.

13. Provide my faculty supervisor with weekly on-going process notes on a minimum of 2 clients a semester. (Practicum, Internship I and II only)

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14. Complete monthly time logs provided by the Department of Counseling. 15. Complete the Comprehensive Time Log at end of 3rd semester.

16. Complete the Comprehensive Internship III Log at end of program.

17. Complete and provide faculty supervisor with weekly schedules of time spent. (Practicum 1, Internship I and II only)

18. There are many forms that need to be completed during my training. Some of these forms and their deadlines will need to be given to my site supervisor. It is my responsibility at the beginning of each semester to ascertain these deadlines and provide the forms to my site supervisor with sufficient time to process them. All of these forms, once completed, need to be submitted to my faculty supervisor.

Practicum Approval Form

Practicum/Internship I, II, III Information Form Internship I Approval Form

Internship II Approval Form Internship III Approval Form

Supervision Agreement and Trainee Goals

Counseling Session (and/or Group) Process Notes Weekly Schedules of time spent

Observation form Monthly Time Log

Comprehensive Time Log

Trainee Evaluation Form - Mid-semester evaluation Trainee Evaluation Form - Final evaluation

Evaluation of Site Supervisor Evaluation of Faculty Supervisor

Trainee Signature ____________________________ Date____________________________________________

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Practicum/Internship Faculty Supervisor Guidelines

Practicum and internships are collaborative partnerships among agencies, site supervisors, student trainees, the Gallaudet University Department of Counseling and the faculty supervisor. The ultimate responsibility for training lies with the faculty supervisor. To honor and assist in this important supervisory role, we offer this guideline.

As a Practicum/Internship Faculty Supervisor, I agree to:

1. Verify that the trainee is eligible to enter into the appropriate level of practicum and internship experience.

2. Provide orientation, training, and on-going contact and consultation to site supervisor. 3. Provide effective and timely feedback to trainees on their performance.

4. Review all submitted forms and maintain student field experience file.

5. Provide a minimum of one hour a week one-on-one supervision and be available for consultation. For out of town internships, this means 1 hour weekly individual supervision on telephone, videophone, or AIM.

6. Provide a minimum of 90 minutes per week of group supervision. For out of town internships, this means weekly group supervision using telephone, AIM chatrooms , BlackBoard, or other synchronous technology.

7. Communicate with student and site supervisor if there is any major concern regarding performance or ethics or if any changes need to be made in structure or timing of practicum or internship.

8. Observe trainee’s work with clients a minimum of twice a semester, or verify the site

supervisor has done so. This observation may be through a one-way window, videotape, or live. 9. Provide additional support and supervision as needed when developmental or remedial performance deficiencies exist.

10. Submit a grade for the student.

Faculty Supervisor Signature _________________________ Date____________________________________________

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FORMS

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GALLAUDET UNIVERSITY Department of Counseling

Mental Health Program Practicum Approval Form

This form should be completed after first semester mid-term grades are available and used at the mid semester program review meeting.

Name of student: ________________________________________ Projected date to begin practicum: __________________________

Mid-semester grades (these courses are prerequisites for practicum with passing grades of ≥ “B-“; FHS and Multicultural grades must be ≥ “B”):

Foundations of Helping Skills: _______ Orientation to MH Counseling: ____ Theories and Approaches: __________ Lifespan Development:

__________

Multicultural Foundations: ___________ Simulated Society: ___ GU-ASLPI rating: _________________ (requires ≥ 2+)

Pre-practicum requirements NOT completed:

________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Recommendations:

Approved for Practicum Not Approved for Practicum (check one)

Faculty Instructor, FHS: ____________________Date:________ Faculty Advisor: __________________________Date:________ Program Director: ________________________ Date:_________ Student Signature: ________________________Date:_________

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GALLAUDET UNIVERSITY Department of Counseling Mental Health Counseling Program

Practicum/Internship I, II, and III Information Form

Student:____________________ Practicum / Internship I / II / III Semester/Yr:___________

Fieldwork Dates (mm/day/yr) Start date:______ End date:_______ Site Address:__________________________

___________________________

___________________________

Site Supervisor/Title/License:________________________________ Site Supervisor’s E-Mail Address: ____________________________ Site Supervisor’s phone/pager numbers: ________________________ Site Supervisor’s VP Number:________________________________ Site Phone and Fax numbers: ________________________________

_________________________________ Site VP Number:___________________________________________ Student’s Mailing address:____________________________________

____________________________________

Student’s E-Mail/T-mail/AOL AIM addresses: ____________________ _________________________________________________________ Student’s phone number contacts: ______________________________

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GALLAUDET UNIVERSITY Department of Counseling

Mental Health Program Internship I Approval Form

This form should be completed between study day and the end of the second semester.

Name of student: ________________________________________ Projected date to begin Internship I: __________________________ Mid-semester grades (these courses are prerequisites for practicum) Practicum 740 ________ (requires “B” or above)

Group Counseling _________ Psychopathology _________

Recommendations:

Approved for Internship I Not Approved for Internship I (check one)

Faculty Supervisor: ____________________Date:________ Faculty Advisor: __________________________Date:________ Program Director: ________________________ Date:_________ Student Signature: ________________________Date:_________

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GALLAUDET UNIVERSITY Department of Counseling

Mental Health Program Internship II Approval Form

This form should be completed after third semester (summer) grades are available.

Name of student: ________________________________________ Projected date to begin Internship II: __________________________ Final semester grades

Internship I ____________ (requires ≥ “B”)

Recommendations:

Approved for Internship II Not Approved for Internship II (check one)

Faculty Supervisor: ____________________Date:________ Faculty Advisor: __________________________Date:________ Program Director: ________________________ Date:_________ Student Signature: ________________________Date:_________

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GALLAUDET UNIVERSITY Department of Counseling Mental Health Counseling Program

Internship III Approval Form

This form must be completed as soon as students have negotiated an internship with an appropriate site (at least two weeks prior to the completion of the

semester preceding the internship).

Name of student:_______________________________ Projected date of graduation: _____________________

Pre-Internship III Requirements:

______ Internship II grade (requires > “B”) ______ Qualifying Exams (> 75%

on each course area)

______GU ASL-PI Rating of > 3

______Passing Grade (> “B” or “B-“) in ALL Required Program Courses Recommendations:

Approved for Internship III Not Approved for Internship III (check one)

Faculty Supervisor: _________________________Date:______________

Academic Advisor: _________Date: Program Director: _________Date: _____ Student: _________Date: _____

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GALLAUDET UNIVERSITY Department of Counseling Mental Health Counseling Program

SUPERVISION AGREEMENT Site: _________________________ Supervisor: ___[name]___________ Supervisee: ____[name]__________

The purpose of this form is to acquaint you and your supervisor, to describe the supervision process, to involve you in structuring your supervision experience, and to give you the opportunity to ask any questions you may have regarding supervision.

Period of Supervision

The period of supervision will be from January ____ to December _____. Supervisor’s Professional Disclosure Statement

[Ask your supervisor to insert a brief statement about his or her credentials (i.e., degree, certification, and license), position within the agency, and any training or experience as a supervisor.]

Supervision Process

Supervision is an interactive process intended to monitor the quality of client care, to improve clinical skills, and to facilitate professional and personal growth. You can expect to receive timely verbal and written feedback on your clinical interventions and to have a supportive environment in which to discuss client-related concerns and the development of your clinical skills. You will be

expected to participate actively in the supervision process, to arrive on time and be prepared for each session, and to complete all required written work in a timely manner.

Supervision is different from therapy, but like therapy, supervision involves

benefits and risks. Possible benefits to you include an improvement of your case conceptualization and intervention skills and an increased sense of professional identity. Some possible risks to you include discomfort arising from close

scrutiny of your knowledge and skills.

A typical supervision session may include [insert a brief description of the expectations for supervision. You need to develop this with your supervisor.] Practical Concerns

We will meet weekly for one-hour individual supervision sessions. [Insert additional practical and/or logistical issues, such as, what to do if you need

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supervision but your supervisor isn’t in the office or how often you will provide your paperwork for review.]

Evaluation and Due Process

Your supervisor will provide you with ongoing written and verbal feedback throughout the period of your training. Formal written evaluations will be

conducted twice each semester—once at the mid point and again at the end of the semester. The supervisor will use the evaluation forms provided by the Department of Counseling. Please read these in advance so that you may become familiar with the areas addressed in the evaluation.

If at any time you are dissatisfied with your supervision or the evaluation process, please discuss this with your field supervisor. If we are unable to resolve your concerns, you should discuss your concerns with your faculty supervisor. Legal/Ethical Issues

You must inform each client of your trainee status and provide them with the name of your supervisor. All documents and reports must also indicate your trainee position.

[Discuss with your supervisor and insert here any additional legal policies specific to your agency, such as, how clinical emergencies are handled or who must be on-site while you are with a client. Make sure to develop this section with your supervisor.]

Supervision is not intended as personal counseling or therapy for you. You are strongly encouraged to seek counseling or therapy if any personal concerns arise. Furthermore, the content of the supervision sessions and evaluations of your development and progress may be shared with [insert names/positions of other people within the agency who the supervisor may talk to about the content of your supervision and evaluations], and faculty from the Department of

Counseling. Information from your supervision may also be disclosed to

appropriate parties if treatment of a client violates the legal or ethical standards set forth by the American Counseling Association (ACA), [insert other applicable organizations, e.g., APA or NASW, depending on your site] , and all laws of [insert either the District of Columbia or Maryland] governing our practice.

Statement of Agreement

I have read, understand and agree to the information contained in this document. _______________________________ ___________________

Supervisee Signature Date

_______________________________ ___________________

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Supervisee Name: ________________________ Semester: _____________________________

Individual Statement of Learning Goals

Goals Method Evaluation

1. 2. 3. 4. 5.

Sample Field Work Goals The following is a sample:

Goals Method Evaluation

1. to demonstrate

improved attending skills in counseling

1a. observe and discuss field supervisor’s

attending skills with clients

1b. focus attention on unrushed “listening” to what a variety of my clients are feeling and saying 1a. discussion observations in supervision 1b. feedback from supervisor(s)

2.to demonstrate better ASL communication skills in counseling

2a. take advanced ASL class

2b. request client assignments with deaf people who communicate in ASL

2a. passing grade in class

2b. client feedback and/or feedback from supervisor observation 3. to demonstrate basic

understanding of clients’ medications

3a. attend client’s appointments with psychiatrist

3b. research common uses for the medications my clients take

3a. field supervisor feedback

3b. field supervisor feedback

4. 5.

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Counseling Session Process Notes Client ID#:

Date:

Session number: General Summary

How did the session open?

What issues/topics were discussed? How did the session close?

Process:

What was client’s attitude? What was client’s affect? What was your affect?

What underlying issues were you aware of?

What were the client’s reactions to you and your comments/interactions? What were your reactions to client’s comments/reactions?

How do you understand this client after this session? Think of behavior, thought processes, and feelings.

What did you learn from this session? This could be about the client, about

yourself, about the process of counseling, or just about anything. Be introspective in your answer.

What will your focus be for the next session

Trainee: Semester:

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Group Counseling Session Progress Notes Group Members (Name Initials):

Date:

Session number:

Group Facilitators/Leaders: Type of Group:

Group Content:

-describe specific topics or issues that were addressed -describe opening and closing of session

-describe any particular exchanges and/or interactions between and among group members and leaders that you felt to be most significant

Group Process:

Describe group members’ attitudes?

Describe group members’ affect throughout session- note any particular changes?

What was your affect?

What underlying issues were you aware of at any point during the group session?

Were there any particular reactions/responses from group members to you or your co-leader(s) comments/interactions?

What were your reactions to group members’ comments/reactions? How do you understand the group’s process after this session? Think of behavior, thought processes, and feelings.

What did you learn from this session? This could be about the group members, about yourself and/or your co-leader(s), about the process of group counseling, or just about anything. Be introspective in your answer.

What will your focus be for the next group session?

Trainee: Semester:

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GALLAUDET UNIVERSITY Department of Counseling

Mental Health Program

TIME LOG

Practicum Internship (check one)

SEMESTER: ____________ MONTH: _______________ YEAR: _____________ Name of Student: _________________________ Site: _____________________________

Total Clock Hours Week 1 Week 2 Week 3 Week 4 Week 5 Monthly

Total Total to Date

Direct Contact Week 1 Week 2 Week 3 Week 4 Week 5 Monthly

TOTAL to Date TOTAL

Intake Interview Individual Counseling Group Counseling, Psycho-Educ Group Family/CouplesTherapy, Parenting Skills Counseling Career/Transition Counseling Case Management w/ client present Case Conference/ meeting w/client present Consultation specific to client w/ client present Other:

TOTAL (Direct Contact )

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Supervision Week 1 Week 2 Week 3 Week 4 Week 5 Monthly

TOTAL to Date TOTAL

Individual- Faculty

Individual- Site

Group- Faculty

Group- Site (case conference/staffing, clinical meeting)

TOTAL Supervision

Indirect Contact Week 1 Week 2 Week 3 Week 4 Week 5 Monthly

TOTAL TOTAL to Date

Case Management

Consultation – general issues

Progress notes, report writing, paperwork; File reviews

Professional

Development/training

Community Outreach

Other:

Student’s Signature: _________________________________________ Date:______________ Site Supervisor’s Signature: Date: ______ Faculty Supervisor’s Signature: ______ Date: # NEW Individual Clients: # NEW Groups: # NEW Families: ____ # Total Individual Clients: Total # Groups: Total # Families:

New Clients This

Month Child Teen Adult Total #

American Indian/Alaskan Asian Black / African American Latino Pacific Islander White Declined

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Gallaudet University Department of Counseling

Mental Health Program COMPREHENSIVE TIME LOG

Practicum Internship (check one) Name of Student: Site:

TOTAL CLOCK HOURS From: To:

# Days =

Spring Semester Summer Semester Fall Semester TOTAL

Direct Contact Spring Semester Summer Semester Fall Semester TOTAL

Intake Interview Individual Counseling Group Counseling, Psycho-Educ Group Family/Couples Therapy, Parenting Skills Counseling Career/Transition Counseling Case Management w/ client present Case Conference/ meeting w/ client present Consultation specific to client w/ client present

TOTAL Direct Contact Supervision Individual- Faculty Individual- Site Group- Faculty Group- Site (case conference/ staffing, clinical meeting)

TOTAL Supervision

Student’s Signature: _______________________ Date: ____________________ Faculty Supervisor’s Signature: ______________ Date: ____________________

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Gallaudet University Department of Counseling Supervisor Observation Form

Observation of trainees counseling skills is an important component of training and the Department requires this be completed at a minimum of twice a

semester. This requirement can be met in either of two ways: direct

observation, with the supervisor in the room or observing through a one way window, or observation of a videotaped session.

Please check this box if sessions are routinely or often observed and select 2 sessions to comment on.

This form confirms that trainee _____________________, was observed on the following dates:

______________________ ______________________ Observation 1:

This was an individual, couple, family, group session (circle one) Comments:

Observation 2:

This was an individual, couple, family, group session (circle one) Comments:

Signature of trainee____________________Date______ Date_______ Signature of supervisor__________________Date______ Date_______

Trainee Name: Practicum

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GALLAUDET UNIVERSITY Department of Counseling

Mental Health Program

Trainee Evaluation Form—Practicum

Student Name:__________________________Semester/Year:__________

The student is to be evaluated on three main areas: knowledge, skills, and dispositions. Please complete the following items with regard to where the student should be in their development at this point in time (i.e., as a first semester practicum student). The form should be used for both mid- and end-of-semester grades.

Scale: Not seen Minimal Satisfactory Good Very Good 0---1---2---3---4

Use “N/A” to designate items that do not apply at this time or at this site.

Knowledge

Using the scale above, please rate the student’s progress on the following knowledge:

Mid/End

___ ___ 1. Student understands the ACA ethical standards.

___ ___ 2. Student understands the structure and purpose of services offered by the practicum site.

___ ___ 3. Student understands basic assessment, problem-solving, and goal-setting strategies.

___ ___ 4. Student understands the constructs of basic case conceptualization. ___ ___ 5. Student understands institutional and social barriers affecting clients at the practicum site.

___ ___ 6. Student understands the expectations and personal processes needed in order to benefit from clinical supervision.

Skills

Using the scale above, please rate the student’s progress on the following skills:

Mid/End

___ ___ 1. Student participates constructively in supervision.

___ ___ 2. Student uses supervisory feedback to modify subsequent counseling behaviors.

___ ___ 3. Student is able to develop and maintain a facilitative and ethical counselor-client relationship.

___ ___ 4. Student helps clients set realistic goals for counseling.

___ ___ 5. Student assists clients in movement toward achieving counseling goals through the use of:

___ ___ a. attentive listening ___ ___ b. probing

___ ___ c. appropriate empathy ___ ___ d. reflecting

___ ___ e. summarizing (content and affect) ___ ___ f. development of a client action plan

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___ ___ 7. Student demonstrates effective case presentation skills.

___ ___ 8. Student communicates effectively in the language preferred by the client. ___ ___ 9. Student keeps accurate and timely clinical and administrative records. ___ ___10. Student adheres to ACA ethical standards and applies ethical professional

decision-making.

___ ___11. Student demonstrates competence in working across cultures.

___ ___12. Student adheres to practicum site policies and procedures that promote ethical and legal professional practice.

___ ___13. Student provides constructive feedback to peers on counseling skills and strategies in a manner that enhances counseling abilities.

___ ___14. Student openly receives and applies feedback from peers, supervisors, and other mental health professionals on counseling skills and strategies. ___ ___15. Student is developing an effective and appropriate working relationship with

agency staff.

Dispositions

Using the scale above, please rate the student’s attitude as it relates to the professional practice of counseling:

Mid/End

___ ___ 1. Student appreciates the value of self-evaluation and the recognition of personal strengths, weaknesses, and limitations.

___ ___ 2. Student appreciates that even small changes in clients can be important for mental health.

___ ___ 3. Student appreciates clients’ assets and strengths.

___ ___ 4. Student values professional development and regards supervision as a significant factor in promoting such development.

___ ___ 5. Student values cross-cultural sensitivity and respects alternative worldviews.

Narrative Feedback

Please comment on the following areas: Please comment on the following areas:

Student’s strengths_______________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Areas needing improvement:_______________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Other__________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Please indicate 1-3 specific, immediate objectives for student’s continued development: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________

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Grade

Based on the above information and given the student’s current expected stage of development, please assign a letter grade (i.e., A+, A, A-, B+, B, B-, C).

Mid-semester grade:______ End-of-semester grade: ______

Student’s signature Date Student’s signature Date Site supervisor’s signature Date Site supervisor’s signature Date Faculty supervisor’s signature Date Faculty supervisor’s signature Date

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GALLAUDET UNIVERSITY Department of Counseling

Mental Health Program

Trainee Evaluation Form—Internship I

Student Name:_______________________Semester/Year:_____________________

The student is to be evaluated on three main areas: knowledge, skills, and dispositions. Please complete the following items with regard to where the student should be in their development at this point in time (i.e., as a second-semester practicum student). The form should be used for both mid- and end-of-semester grades.

Scale: Not seen Minimal Satisfactory Good Very Good 0---1---2---3---4

Use “N/A” to designate items that do not apply at this time or at this site.

Knowledge

Using the scale above, please rate the student’s progress on the following knowledge:

Mid/End

___ ___ 1. Student understands the application of ACA ethical standards. ___ ___ 2. Student understands crisis protocol of the practicum site.

___ ___ 3. Student understands various counseling theories relevant to work with their client population.

___ ___ 4. Student understands the assessment, intake, counseling, and termination procedures specific to their agency.

___ ___ 5. Student understands the unique presentation of dual relationships within the deaf community.

___ ___ 6. Student understands the expectations and personal processes needed in order to benefit from clinical supervision.

Skills

Using the scale above, please rate the student’s progress on the following skills:

Mid/End

___ ___ 1. Student demonstrates continued progress on skills learned in Practicum I. ___ ___ 2. Student demonstrates the ability to develop a treatment plan.

___ ___ 3. Student is able to provide clinical rationale for work with clients, including the integration of counseling theories to work.

___ ___ 4. Student assists clients in movement toward achievement of counseling goals by effectively applying increasingly sophisticated counseling skills and techniques:

___ ___ a. paraphrasing ___ ___ b. probing

___ ___ c. summarizing (content and affect) ___ ___ d. interpretation

___ ___ e. challenging

___ ___ 5. Student is able to identify the relevant of “sub-themes” in the client’s issues. ___ ___ 6. Student is able to recognize transference and countertransference and

discuss the related implications in supervision.

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___ ___ 8. Student is able to terminate counselor-client relationships in a therapeutic manner.

___ ___ 9. Student adheres to ACA ethical standards and applies ethical professional decision-making.

___ ___10. Student communicates effectively in the language preferred by the client. ___ ___11. Student keeps accurate and timely clinical and administrative records. ___ ___12. Student demonstrates competence in working across cultures.

___ ___13. Student adheres to practicum site policies and procedures that promote ethical and legal professional practice.

___ ___14. Student participates constructively in supervision and uses supervisory feedback to modify subsequent counseling behavior.

___ ___15. Student demonstrates effective case presentation skills.

___ ___16. Student provides constructive feedback to peers and colleagues on counseling skills and strategies in a manner that enhances counseling abilities.

___ ___17. Student has an effective and appropriate working relationship with agency staff.

Dispositions

Using the scale above, please rate the student’s attitude as it relates to the professional practice of counseling:

Mid/End

___ ___ 1. Student appreciates the value of self-evaluation and the recognition of personal strengths, weaknesses, and limitations.

___ ___ 2. Student appreciates that even small changes in clients can be important for mental health.

___ ___ 3. Student appreciates clients’ assets and strengths.

___ ___ 4. Student values professional development and regards supervision as a significant factor in promoting such development.

___ ___ 5. Student values cross-cultural sensitivity and respects alternative worldviews.

Narrative Feedback

Please comment on the following areas: Student’s strengths:______________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Areas needing improvement:_________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Other:_________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________

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Please indicate 1-3 specific, immediate objectives for student’s continued development: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________

Grade

Based on the above information and given the student’s current expected stage of development, please assign a letter grade (i.e., A+, A, A-, B+, B, B-, C).

Mid-semester grade:______ End-of-semester grade: ______ ___________________________ _________ _______________________ Student’s signature Date Student’s signature Date ___________________________ _______ ______________________________ Site supervisor’s signature Date Site supervisor’s signature Date ___________________________ _______ ______________________________ Faculty supervisor’s signature Date Faculty supervisor’s signature Date

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GALLAUDET UNIVERSITY Department of Counseling

Mental Health Program

Trainee Evaluation Form—Internship II

Student Name:____________________________Semester/Year:________________

The student is to be evaluated on three main areas: knowledge, skills, and dispositions. Please complete the following items with regard to where the student should be in their development at this point in time (i.e., as a third-semester practicum student). The form should be used for both mid- and end-of-semester grades.

Scale: Not seen Minimal Satisfactory Good Very Good 0---1---2---3---4

Use “N/A” to designate items that do not apply at this time or at this site.

Knowledge

Using the scale above, please rate the student’s progress on the following knowledge:

Mid/End

___ ___ 1. Student understands the application of ACA ethical standards.

____ __ 2. Student understands various counseling theories relevant to work with their client population.

___ ___ 3. Student understands the assessment, intake, counseling, and termination procedures specific to their agency.

___ ___ 4. Student has a deepened understanding of the unique presentation of dual relationships within the deaf community.

___ ___ 5. Student understands the expectations and personal processes needed in order to benefit from clinical supervision.

Skills

Using the scale above, please rate the student’s progress on the following skills:

Mid/End

___ ___ 1. Student demonstrates continued progress on skills learned in Practicum I and II.

___ ___ 2. Student demonstrates the ability to develop and effectively implement a treatment plan.

___ ___ 3. Student is able to provide clinical rationale for work with clients, including the integration of counseling theories to work.

___ ___ 4. Student assists clients in movement toward achievement of counseling goals by effectively applying basic and advanced counseling skills and techniques.

___ ___ 5. Student conceptualizes cases using a sophisticated structure (e.g., identifying sub-themes and patterns, and connecting client patterns with knowledge of psychological disorders and human growth and development) ___ ___ 6. Student is able to utilize transference and countertransference within

counseling session.

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___ ___ 8. Student is able to terminate counselor-client relationships in a therapeutic manner.

___ ___ 9. Student adheres to ACA ethical standards and applies ethical professional decision-making.

___ ___10. Student communicates effectively in the language preferred by the client. ___ ___11. Student keeps accurate and timely clinical and administrative records. ___ ___12. Student demonstrates competence in working across cultures.

___ ___13. Student adheres to practicum site policies and procedures that promote ethical and legal professional practice.

___ ___14. Student participates constructively in supervision and uses supervisory feedback to modify subsequent counseling behavior.

___ ___15. Student demonstrates effective case presentation skills.

___ ___16. Student provides constructive feedback to peers and colleagues on counseling skills and strategies in a manner that enhances counseling abilities.

___ ___17. Student effectively terminates counselor-supervisor relationship and relationship with agency.

Dispositions

Using the scale above, please rate the student’s attitude as it relates to the professional practice of counseling:

Mid/End

___ ___ 1. Student appreciates the value of self-evaluation and the recognition of personal strengths, weaknesses, and limitations.

___ ___ 2. Student values professional development and regards supervision as a significant factor in promoting such development.

___ ___ 3. Student appreciates clients’ assets and strengths.

___ ___ 4. Student respects clients and values the relationship with clients above the performance of techniques.

___ ___ 5. Student values cross-cultural sensitivity and respects alternative worldviews.

___ ___ 6. Student values flexibility and openness in the practice of counseling, yet desires clinical consistency and scientifically-based rationales for

counseling strategies and interventions.

Narrative Feedback

Please comment on the following areas:

Student’s strengths:______________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ __________

Areas needing improvement:_______________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Other:_________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________

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Please indicate 1-3 specific, immediate objectives for student’s continued development: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________

Grade

Based on the above information and given the student’s current expected stage of development, please assign a letter grade (i.e., A+, A, A-, B+, B, B-, C).

Mid-semester grade:______ End-of-semester grade: ______

_______________________________ _________________________________ Student’s signature Date Student’s signature Date _____________________________________________________________________ Site supervisor’s signature Date Site supervisor’s signature Date _____________________________________________________________________ Faculty supervisor’s signature Date Faculty supervisor’s signature Date

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GALLAUDET UNIVERSITY Department of Counseling

Mental Health Program

Trainee Evaluation Form—Internship III

Student Name:____________________________ Semester/Year:______________

The student is to be evaluated on three main areas: knowledge, skills, and dispositions. Please complete the following items with regard to where the student should be in their development at this point in time. The form should be used for both mid- and end-of-semester grades.

Scale: Not seen Minimal Satisfactory Good Very Good 0---1---2---3---4

Use “N/A” to designate items that do not apply at this time or at this site.

Knowledge

Using the scale above, please rate the student’s progress on the following knowledge:

Mid/End

___ ___ 1. Student understands the application of ACA ethical standards.

___ ___ 2. Student understands the structure and purpose of services offered by the internship site.

___ ___ 3. Student understands various counseling theories relevant to work with the client

population.

___ ___ 4. Student understands the assessment, intake, counseling, and termination procedures specific to the internship site.

___ ___ 5. Student understands institutional and social barriers affecting clients at the internship site.

___ ___ 6. Student understands the expectations and personal processes needed in order to benefit from clinical supervision.

___ ___7. Student expands knowledge of clinical practice through reading current relevant professional literature.

Skills

Using the scale above, please rate the student’s progress on the following skills:

Mid/End

___ ___ 1. Student adheres to ACA ethical standards and applies ethical professional decision-making skills.

___ ___ 2. Student adheres to internship site policies and procedures that promote ethical and legal professional practice.

___ ___ 3. Student can articulate a personalized approach to counseling based on established counseling theory(ies), empirically supported interventions, supervision, and client interaction.

___ ___ 4. Student effectively performs a full range of counseling duties, including: ___ ___ a. screenings

___ ___ b. intakes ___ ___ c. assessment

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___ ___ d. treatment planning ___ ___ e. crisis intervention ___ ___ f. case management ___ ___ g. psychoeducation ___ ___ h. individual counseling ___ ___ i. couples counseling ___ ___ j. group counseling

___ ___ 5. Student can formulate and deliver an empirically-supported treatment plan for a clinical case.

___ ___ 6. Student assists clients in movement toward achievement of counseling goals by effectively applying basic and advanced counseling skills and techniques.

___ ___ 7. Student demonstrates advanced case conceptualization skills. ___ ___ 8. Student demonstrates effective case presentation skills.

___ ___ 9. Student routinely identifies, discusses, and effectively works with multi-cultural and cross-multi-cultural issues surrounding specific cases.

___ ___10. Student identifies and discusses ethical issues surrounding cases. ___ ___11. Student communicates effectively in the language preferred by the client. ___ ___12. Student is able to terminate counselor-client relationships in a therapeutic

manner.

___ ___13. Student keeps accurate and timely clinical and administrative records. ___ ___14. Student participates constructively in supervision and uses supervisory

feedback to modify subsequent counseling behavior.

___ ___15. Student provides constructive feedback to peers and colleagues on counseling skills and strategies in a manner that enhances counseling abilities.

___ ___16. Student openly receives and applies feedback from peers and colleagues on counseling skills and strategies.

___ ___17. Student has an effective and appropriate working relationship with agency staff.

___ ___18. Student integrates new knowledge gained from the current professional literature into supervision and counseling sessions.

___ ___19. Student effectively terminates counselor-supervisor relationship.

Dispositions

Using the scale above, please rate the student’s attitude as it relates to the professional practice of counseling:

Mid/End

___ ___ 1. Student appreciates the value of self-evaluation and the recognition of personal strengths, weaknesses, and limitations.

___ ___ 2. Student values professional development and regards supervision as a significant factor in promoting such development.

___ ___ 3. Student appreciates clients’ assets and strengths.

___ ___ 4. Student values the effectiveness of preventive interventions in working with clients.

___ ___ 5. Student values cross-cultural sensitivity and respects alternative worldviews.

___ ___ 6. Student values flexibility and openness in the practice of counseling, yet desires clinical consistency and scientifically based rationales for

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___ ___ 7. Student respects clients and values the relationship with clients above the performance of techniques.

Narrative Feedback

Please comment on the following areas:

Student’s strengths:______________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Areas needing improvement:_______________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Other:_________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Please indicate 1-3 specific, immediate objectives for student’s continued development: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________

Grade

Based on the above information and given the student’s current expected stage of development, please assign a letter grade (i.e., A+, A, A-, B+, B, B-, C).

Mid-semester grade:______ End-of-semester grade: ______ ___________________________ _________ _____________________________ Student’s signature Date Student’s signature Date ___________________________ _______ _________________________________ Site supervisor’s signature Date Site supervisor’s signature Date ___________________________ _______ _________________________________ Faculty supervisor’s signature Date Faculty supervisor’s signature Date

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GALLAUDET UNIVERSITY Department of Counseling

Student Counselor Evaluation of Site Supervisor

Practicum Internship (check one) Semester _______ Year _______

Name of site supervisor: ____________________________________ Name of student:__________________________________________ Site: ___________________________________________________

Directions: Please circle the number that best represents how you, the student counselor, feel about the supervision received. When you think about your

responses, please consider both individual and group supervision time. If there is a difference between the 2 processes, please explain.

Schedule and Availability

Poor OK Good 1. Overall, approximately how closely did the actual supervision 1 2 3 4 5 6 contacts match the agreed upon plan?

2. Apart from scheduled meetings, how available was your 1 2 3 4 5 6 supervisor if you requested additional contact?

3. Scheduled supervision time was clearly and carefully protected. 1 2 3 4 5 6 4. The supervisor observed my clinical work on 1 2 3 4 5 6 at least two occasions and provided feedback for each observation.

Introduction To Setting

5. Did your supervisor give you a tour or arrange for a tour of the Yes ___ No ___ site? Satisfaction: Yes or No 6. Did your supervisor introduce you to other staff when you began Yes ___ No ___ the practicum/internship? Satisfaction: Yes or No 7. Did your supervisor discuss procedural matters, agency policy, Yes ___ No ___ and the like? Satisfaction: Yes or No 8. Did your supervisor discuss ethical and legal issues when you Yes ___ No ___ began the practicum/internship? Satisfaction: Yes or No Activities at the Practicum/Internship

Approximately what percentage (0 -100) of your training was spent in each of the following activities?

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clients, but not directly observing or participating in treatment or Satisfaction:Yes or No other services.

10. Interacting informally with staff members. Percentage ______ Satisfaction: Yes or No 11. Observing treatment, assessment, or other direct services with Percentage _____

clients. Satisfaction: Yes or No

12. Participating in or providing treatment, assessment, or other Percentage _____ direct service with clients. Satisfaction: Yes or No 13. Attending meetings other than supervision or informal Percentage _____ conversation. Satisfaction: Yes or No 14. Reading records, reports, and the like. Percentage _____

Satisfaction: Yes or No

15. Writing case notes, assessments, reports, correspondence, Percentage _____ and the like. Satisfaction: Yes or No 16. Please describe and evaluate other activities you participated in.

Supervision

As you know, supervisors have different styles. Listed below are activities many site supervisors spend time on during supervision. Please rate your satisfaction

with both how often you used these activities and the process of supervision. Poor OK Good

17. Using case notes or material to review my work with clients. 1 2 3 4 5 6 18. Observing supervisor providing treatment, assessments, or 1 2 3 4 5 6 other services to clients.

19. Discussing institutional issues. 1 2 3 4 5 6 20. Didactic instruction in specific topics or skills. 1 2 3 4 5 6 21. Reviewing and editing reports or case notes I have written. 1 2 3 4 5 6 22. Using dialogue and verbal expression to review my work with 1 2 3 4 5 6 clients.

23. Discussing my personal impressions, reactions and adjustment 1 2 3 4 5 6 to the internship.

24. Discussing my relationship with my supervisor. 1 2 3 4 5 6 25. I felt my supervisor listened to me respectfully. 1 2 3 4 5 6

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26. I felt comfortable talking to my supervisor about weaknesses, 1 2 3 4 5 6 confusion or doubts.

27. My supervisor gave me helpful feedback when I made mistakes. 1 2 3 4 5 6 28. My supervisor recognized and complimented me on my growth 1 2 3 4 5 6 and accomplishments.

29. My supervisor’s Sign Language skills were good. 1 2 3 4 5 6 30. I would recommend this supervisor to other students. 1 2 3 4 5 6

Based on your experience, briefly describe ways in which you feel supervision was helpful to you.

If there was anything about supervision that was not helpful, please explain.

In what ways do you think your supervision could have been more beneficial to you?

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GALLAUDET UNIVERSITY Department of Counseling

Student Counselor Evaluation of Faculty Supervisor

Practicum Internship (check one)

Semester ____________ Year_____________ Name of faculty supervisor: Name of student:

Please circle the answer that best reflects your experience.

1. The supervision time was well planned.

Poor Adequate Good 2. The expectations of the supervision time were explained well.

Poor Adequate Good 3. Scheduled supervision time was clearly and carefully protected.

Poor Adequate Good 4. My supervisor was available outside of scheduled appointments.

Poor Adequate Good

5. My supervisor listened to me respectfully.

Poor Adequate Good

6. My supervisor paid attention to both me and my clients.

Poor Adequate Good

7. I learned important skills and knowledge from my supervisor.

Poor Adequate Good

8. I felt comfortable talking to my supervisor about weaknesses, confusion or doubts.

Poor Adequate Good

9. My supervisor recognized and complimented me on my growth and accomplishments during the semester.

Poor Adequate Good

Figure

Updating...

References

Outline : ACA Code of Ethics